Quick Start: Where Are You Right Now?

Introduction

Vaginal dryness is incredibly common after menopause—and very treatable. You don't have to "put up with it." This guide explains what's happening, what actually works, and how to choose next steps that fit your life, with every claim grounded in UK-relevant evidence. [1,2,3,6,10]

What is GSM—and how does vaginal dryness fit in?

GSM = the umbrella for post-menopausal vaginal/vulval and urinary symptoms linked to low oestrogen; dryness is one of the most common. [1,2,3] The term replaces "atrophic vaginitis" to reflect that urinary symptoms often co-exist and there isn't always inflammation. [1,2,3] Recognising GSM steers a stepwise, preference-sensitive plan rather than a one-size-fits-all approach. [1,3,6]

Context (no duplication): Overview—https://thewomenshealth.clinic/vaginal-atrophy/

 

Symptoms of GSM

Genital & Vaginal Symptoms

Vaginal drynessBurning, soreness, or itchingVaginal discharge, The vagina feeling shorter or tighter

Sexual Symptoms

Pain, discomfort, or dryness during sex (dyspareunia), Light bleeding after sexLoss of libido (often due to fear of pain)

Urinary Symptoms

Needing to wee more often (frequency), Sudden desperate need to wee (urgency), Pain on urination (dysuria), Recurrent Urinary Tract Infections (UTIs)Stress incontinence
   

What changes happen after menopause?

Falling oestrogen thins and dries the vaginal lining, reduces elasticity and raises vaginal pH; the lower urinary tract is also oestrogen-sensitive, which explains urgency and recurrent infections alongside dryness. [1,2,3,6] These changes increase micro-trauma and discomfort with sex; local oestrogen directly addresses tissue health, while moisturisers/lubricants support comfort. [1,3,6,9]

See lived-experience + tips: https://thewomenshealth.clinic/vaginal-dryness/

Will vaginal dryness go away on its own?

Typically, no—GSM reflects persistently low oestrogen after menopause, so symptoms often continue or gradually worsen without treatment. [1,2,3] Severity varies; many manage well with moisturisers, while others need prescriptions. Starting early usually makes maintenance easier. [1,3,6]

Stepwise UK pathway: where should I start?

UK guidance supports a laddered approach: moisturiser/lubricant → local oestrogen for persistent/moderate–severe symptoms → prasterone/ospemifene if needed → review. [1,3,6,10]

Shared decision-making + a maintenance plan beat one-off "courses." [1,3,6,10]

How do I know if moisturisers aren't enough?

If you've used a quality moisturiser consistently for 4–6 weeks and still have significant discomfort—or recurrent UTIs—it's time to discuss local oestrogen. [1,3,4,9] If dryness is affecting intimacy or daily life despite lubricant, step up. [1,3]

Local (vaginal) oestrogen: what to expect week by week

Weeks 1–2 (loading): frequent use; tissues begin adjusting; mild messiness/irritation is possible. [1,6,9]

Weeks 3–4: less rawness, more comfort emerging. [1,6]

Weeks 6–8: meaningful improvement for most; move to maintenance 2–3× weekly. [1,6,9]

3–6 months: benefits plateau; ongoing use keeps gains because oestrogen remains low after menopause. [1,2,3,6]

 

Types of Local Oestrogen Available in the UK

Your GP or menopause specialist can prescribe local oestrogen in several forms. The most common UK-prescribed options include: 

 

Vaginal Pessaries (Tablets): These are small tablets inserted with an applicator. UK brands include Vagifem® and Vagirux®. The brand Gina® is now also available over-the-counter in the UK after a pharmacist consultation. 

 

Vaginal Creams: These are applied inside and around the vagina. The most common UK brand is Ovestin®. 

 

Vaginal Rings: This is a soft, flexible ring that sits in the vagina and releases a steady dose of oestrogen. The UK brand is Estring®.

 

Safety: do I need a progestogen with local oestrogen?

No. With low-dose local oestrogens, systemic absorption is minimal, so routine progestogen isn't required; do seek assessment for any unexpected bleeding. [1,5,6] Systematic reviews/observational data do not show increased endometrial cancer risk at low vaginal doses. [5,6] This differs from systemic HRT, where endometrial protection is considered for those with a uterus. [1]

Is vaginal dryness linked to recurrent UTIs?

Yes. NICE NG112 advises considering vaginal oestrogen to reduce recurrent UTIs in post-menopausal people. [4] Oestrogen supports the vaginal epithelium and micro-environment, likely lowering susceptibility to ascending infections; clinicians combine this with hydration and other prevention strategies as appropriate. [3,4]

More on UTIs: https://thewomenshealth.clinic/urinary-tract-infections-uti/

Can vaginal DHEA help if I can't or don't want to use oestrogen?

Prasterone (DHEA) pessaries can improve dyspareunia/dryness related to GSM and are oestrogen-free (converted locally within tissues). [10,11] Suitability and access vary; it's an option when oestrogen is not preferred or tolerated. [10,11] Ospemifene (oral SERM) is another route for moderate–severe dyspareunia; risks/benefits depend on history. [10,12]

Treatment sequencing (internal): https://thewomenshealth.clinic/faq/in-what-order-should-i-try-moisturisers-local-oestrogen-devices-or-injectables/

Are hyaluronic-acid moisturisers different to lubricants?

Yes. Moisturisers support the lining between sex; lubricants reduce friction during sex/exams. [1,9] HA-based moisturisers hold water well and are generally well tolerated. [1,9] For persistent GSM, local oestrogen addresses the underlying tissue changes; moisturiser + lubricant still play supportive roles. [1,6,10]

Non-Hormonal Options: Moisturisers & Lubricants

It's important to know the difference between these two products, as they have very different jobs. Vaginal Moisturisers (for Regular Health): These are for regular use (e.g., every 2-3 days), regardless of sexual activity. They are absorbed into the vaginal tissue to improve hydration and restore moisture. Think of them as a long-acting "face moisturiser" for your vagina. Hyaluronic acid (HA) based moisturisers are excellent at holding water and are generally very well tolerated.

Vaginal Lubricants (for Sexual Activity): These are for use during sex (or pelvic exams) only. They are not absorbed; they stay on the surface to reduce friction and make sex more comfortable and less painful.

Compare products (internal):

• Moisturiser vs lubricant: https://thewomenshealth.clinic/faq/moisturiser-vs-lubricant-whats-the-difference-and-when-to-use-each/
• Water vs silicone vs oil: https://thewomenshealth.clinic/faq/water-based-vs-silicone-vs-oil-based-lubricants-pros-and-cons/

Breastfeeding & dryness—what are safe options?

Breastfeeding can lower oestrogen and trigger GSM-like dryness; start with non-hormonal moisturisers/lubricants and discuss prescriptions individually. [1,9] Low-dose local oestrogen has minimal systemic absorption but requires a tailored conversation during lactation. [1,9]

Internal: Safe options while breastfeeding—https://thewomenshealth.clinic/faq/safe-options-for-dryness-while-breastfeeding/

Do copper or hormonal IUDs affect dryness or comfort?

IUDs don't treat GSM and generally don't cause GSM, which is driven by low oestrogen; some people have IUD-related discomfort that can be confused with dryness. [1] Review helps separate device issues (e.g., strings/position) from GSM so each can be addressed properly. [1]

Internal: IUDs and comfort—https://thewomenshealth.clinic/faq/can-copper-or-hormonal-iuds-affect-dryness-or-comfort/

Red-flag symptoms that need urgent review

Seek prompt assessment for post-menopausal bleeding, severe pain, foul discharge with fever, flank pain with fever, new lumps/ulcers, or urinary retention—these aren't typical of straightforward GSM and need timely evaluation. [1,4]

Full checklist (internal): https://thewomenshealth.clinic/faq/what-red-flag-symptoms-mean-i-should-seek-urgent-review/

Do probiotics help GSM or recurrent infections?

Evidence isn't strong enough to recommend probiotics as core therapy for GSM or for preventing post-menopausal rUTIs; consider them adjunctively if desired, but prioritise proven options like vaginal oestrogen. [3,4]

Internal: Probiotics & GSM/UTIs—https://thewomenshealth.clinic/faq/do-probiotics-help-with-gsm-or-recurrent-infections/

Can I use laser/RF if I'm on HRT?

NICE classifies vaginal laser for GSM as investigational (research-only), and the FDA warns against energy-based devices for "vaginal rejuvenation" due to unproven benefit and possible harms; this stance doesn't change if you're on HRT. [7,8] Consider evidence-based alternatives first. [1,3,6,10]

Internal: NICE & energy-based treatments—https://thewomenshealth.clinic/faq/what-does-nice-say-about-energy-based-treatments-for-dryness/

Explainer: https://thewomenshealth.clinic/vaginal-rejuvenation/

Does pelvic floor overactivity contribute to discomfort?

Yes—pelvic floor overactivity can amplify pain with sex; addressing GSM and muscle overactivity (physio, paced exposure, dilators) often works best. [1,3] Relaxation-focused pelvic physio (not "just Kegels") plus generous lubricant can break the pain–tension cycle. [1,3]

Internal: Pelvic physio & discomfort—https://thewomenshealth.clinic/faq/can-pelvic-floor-physio-help-dryness-related-discomfort/

Lichen sclerosus: follow-up, emollients & sex comfort

LS is a chronic vulval skin condition that can coexist with GSM; management uses potent topical steroids, emollients and regular follow-up; any new lesions/change warrants review. [1] If GSM is also present, local oestrogen can be added. [1]

Internal: LS service page—https://thewomenshealth.clinic/lichen-sclerosus/ | Biopsy considerations—https://thewomenshealth.clinic/faq/when-is-a-biopsy-considered-for-vulval-symptoms/

Vaginismus vs dyspareunia: how do I tell the difference?

Dyspareunia = pain with sex (many causes, including GSM); vaginismus = involuntary pelvic floor tightening that blocks/limits penetration—often co-exists with GSM in midlife. [1,3] Supportive history, optional exam, pelvic physio and psychosexual approaches help alongside GSM care. [1,3]

Internal: Dyspareunia—https://thewomenshealth.clinic/dyspareunia/ | Dilators/physio—https://thewomenshealth.clinic/faq/do-dilators-or-pelvic-floor-therapy-help-painful-sex/

Devices & aesthetics: research-only, safety first

For GSM, energy devices remain research-only in the UK; for aesthetics (fillers/PRP/skin boosters, pigmentation), evidence is limited—discuss reversibility, PIH risk and realistic expectations; prioritise safety and consent. [7,8]

Internal: Sessions/spacing—https://thewomenshealth.clinic/faq/how-many-sessions-are-typical-and-how-far-apart/ | Combining treatments—https://thewomenshealth.clinic/faq/can-i-combine-laser-rf-with-prp-or-polynucleotides-for-dryness/

When will I feel better, and how do I maintain results?

GSM is a long-term change, so think sustainable maintenance, not a one-off fix. [1,2,3,6]

Real Questions from Our Clinic

Talking points for your appointment

Bring: your top symptoms, what you've already tried, your preferences (hormonal or not), and questions on timelines, safety and follow-up. [1,3,6,10] Ask about formulation choices (cream/tablet/pessary/ring), how to maintain benefits, and what the next step would be if needed. [1,6,9,10]

Prep tool: https://thewomenshealth.clinic/online-womens-health-interactive-triage-tool/

Book: https://thewomenshealth.clinic/online-booking/

Statistics

Conclusion & Booking

You deserve comfortable, confident, pain-free intimacy and everyday comfort—without tip-toeing around dryness. Start simple, step up when needed, and keep what works. Local oestrogen is the workhorse for persistent symptoms; non-oestrogen options exist when that's your preference; pelvic physio and thoughtful product use round out the plan. [1,3,6,9,10]

References